Iowa WIC Mothers Experience

More Traumatic Stress

BROOKE MEHNER, MPH IOWA DEPARTMENT OF PUBLIC HEALTH

Stress

“A reaction to a situation where a person feels threatened or anxious. Stress can be positive (e.g., preparing for a wedding) or negative (e.g., dealing with a natural disaster). The symptoms may be physical or emotional.” (CDC, 2018)

Common side effects:Sleeping too much or too little

Feeing sad, frustrated, and helpless

Wanting to be alone

Loss of appetite

Headaches, back pains and stomach problems

Increased heart rate, difficulty breathing

Smoking or use of alcohol or drugs

SOURCE: CDC, 2018

Stress One of the Top 10 Social Determinants of Health Inequities

Associated with low-income populations

Continued anxiety, insecurity, low self-esteem, social isolation and lack of control over work and home lifePowerful impacts on mental and physical health Increased chances of poor mental health and premature death;

Feeling tense too often or for too long increases the risk for many serious health conditions, including infections, diabetes, high blood pressure, heart attack, stroke, depression and aggression

Long periods of anxiety and insecurity and lack of supportive friendships are damaging

The lower people are in the social hierarchy of industrialized countries, the more common these problems

Stressful events before and/or during pregnancy can impact the health across generations

SOURCE: WHO, 2003

Stress

SOURCE: CDC, 2018

HEALTHY WAYS TO COPE SOCIAL DETERMINANTS OF HEALTH

Eat healthy, well-balanced meals Food security

Exercise regularly Neighborhood safety

Sleep Finances

Talk to others Social network

Give yourself a break And others

Time for Some

Audience

Participation!

STUDY QUESTION

Comparing Iowa WIC and non-WIC mothers, what are the differences in the amount and types of stress experienced in the 12

months before infant birth and the association with poor mood?

Methods

Iowa 2013-2015 PRAMS data

Iowa WIC population most reliable

Poor mood:Selecting “Always” or “Often” to P7 Core Questions 54 & 55 :

Q54: Since your baby was born, how often have you felt down, depressed or hopeless?

Q55: Since your new baby was born, how often have you had little interest or little pleasure in doing things?

Methods

14 stressors experienced in the 12 months before infant birth (P7 Core Question 36) Continuous count (0-14)

4 Categories

EMOTIONAL(1) Family ill;(2) Someone close died

FINANCIAL(1) Moved; (2) Husband/partner lost job; (3) Mom lost job; (4) Husband/partner reduced pay/work; (5) Couldn’t pay bills

PARTNER-ASSOCIATED(1) Divorced; (2) Arguing with husband/partner;(3) Husband/partner didn’t want to be pregnant;(4) A part from husband/partner (work related)

TRAUMATIC(1) Husband/partner/self went to jail;(2) Someone close had problem with drinking or drugs

Results – DescriptivesWIC NON-WIC

% [CI] MEAN [CI] % [CI] MEAN [CI]

ALL 36.6 [34.2-39.0] 63.5 [61.0-65.8]

RACE/ETHNICITY

NH White/Other/Unknown 72.3 [70.3-74.3] 93.8 [93.3-94.2]

NH Black 10.7 [9.9-11.5] 2.47 [2.2-2.7]

Hispanic 17.0 [15.8-18.3] 3.8 [3.5-4.1]

AGE

14-19 12.7 [10.2-15.7] 1.55 [0.9-2.6]

20-24 33.9 [30.0-38.0] 11.93 [9.9-14.3]

25-29 29.61 [25.9-33.6] 37.6 [34.5-40.8]

30-34 16.03 [13.3-19.1] 34.6 [31.6-37.8]

35+ 7.8 [6.0-10.1] 14.3 [12.1-16.7]

EDUCATION

Less Than HS 18.8 [16.3-21.7] 4.5 [3.3-6.1]

HS 40.2 [36.1-44.4] 10.7 [8.7-13.1]

Some college 35.8 [31.8-39.9] 33.2 [30.8-36.4]

College+ 5.2 [3.7-7.4] 51.59 [48.3-54.9]

*All values are statistically significant

Results – DescriptivesWIC NON-WIC

% [CI] MEAN [CI] % [CI] MEAN [CI]

GEOGRAPHY

Urban 56.5 [52.3-60.5] 65.2 [62.0-68.3]

Rural 43.6 [39.5-47.7] 34.8 [31.7-38.0]

FEDERAL POVERTY LEVEL (FPL)

0-49% 38.8 [34.6-43.2] 5.9 [4.5-7.6]

50-184% 50.6 [46.2-55.1] 19.5 [17.0-22.4]

185-374% 9.0 [6.6-12.2] 33.4 [30.3-36.6]

375% + -- 41.3 [38.1-44.6]

INSURANCE (During Pregnancy)

Public 64.1 [59.9-68.0] 10.8 [9.0-13.0]

Private 31.2 [27.3-35.3] 87.0 [84.6-89.1]

None 4.8 [3.8-6.0] 2.2 [1.4-3.5]

*All values are statistically significant value--Suppressed values (<25 respondents)

Results – Stress (Rates)

7 IN 10 2 IN 10

FINANCIAL PARTNER TRAUMATIC

2 IN 5

1 IN 54 IN 10 1 IN 10

WIC

Non-WIC

STRESSORS

3.0

1.7

EMOTIONAL

3 IN 10

3 IN 10

Results – Poor Mood (RATES)

1.5 IN 10WIC

<1 IN 10Non-WIC

More than DOUBLE the rate of WIC postpartum moms are considered to have poor mood.

Results – Poor mood (Odds)

2.4 WIC

1 Non-WIC

WIC mothers have more than 2x higher odds of experiencing poor mood.

Results – Stressors

3.0 OR WIC

1.66 OR Non-WIC

WIC mothers experience 1.35 more stressors in the 12 months before delivery than non-WIC mothers.

Results – Poor mood

The total number of stressors experienced before delivery has a slightly lesser impact on postpartum poor mood in the WIC population than in the non-WIC population.

1.21 OR WIC

1.39 OR Non-WIC

Results – Stress (Odds)

WIC mothers have a 17% increased odds of experiencing emotional stress (not statistically significant).

17%

WIC moms are also 3x more likely to experience financial stress than non-WIC moms.

Results – Stress (Odds)

WIC Non-WIC

PARTNER-ASSOCIATED

TRAUMATIC

WIC mothers have a 3x greater odds of experiencing partner-associated stress

and more than 2x greater odds of experiencing traumatic stress.

Results Summary

Before delivery, WIC mothers have: WIC NON-WIC

1.2x greater odds of experiencing emotional stress

3x greater odds of experiencing partner-associated stress

More than 2x the odds of experiencing traumatic stress

Postpartum, WIC mothers have: WIC NON-WIC

2x greater odds to experience poor mood

Limitations

Mixed data sourcesBirth Certificate

PRAMS self-report

Dose of stress is not equally processed by every individual

Unaware of positive versus negative stressi.e. moving

Conclusions &

Public Health Implications

Iowa WIC mothers experience higher rates and greater odds of emotional,

partner-associated, and

traumatic stress, potentially leading to adverse health outcomes.

Poor mood rate differences may demonstrate a need for postnatal care and mental health care accessibility.

WIC, Title V clinics, and other organizations interacting with pregnant women may consider new activities or available resources to aide in traumatic and partner-associated stress prevention and treatment.

Mental health is crucial to a long, happy and fulfilling life; now and for future generations.

Future analysis – if/what is the effect on health

Thank you!QUESTIONS?

Also, Thank you to:

The Iowa PRAMS mothers,

Jennifer Pham, the PRAMS Project Coordinator and

all others who assisted in the making of this presentation.

ResourcesBrondolo, Elizabeth, et al. “Stress and Health Disparities: Contexts, Mechanisms and Interventions Among

Racial/Ethnic Minority and Low Socioeconomic Status Populations.” American Psychological Association, 2017.

Burns, Elizabeth R., et al. “Stressful Life Events Experienced by Women in the Year Before Their Infant's Birth - United States, 2000-2010.” Morbidity and Mortality Weekly Report, vol. 64, no. 9, 13 Mar. 2015.

Center for Disease Control and Prevention. (2018, January 09). Violence Prevention: Coping with Stress. Retrieved from https://www.cdc.gov/ViolencePrevention/pub/coping_with_stress_tips.html

Hanley J., “Listening Visits in Perinatal Mental Health: A Guide for Health Professionals and Support Workers.” Abingdon, Oxon: Routledge; 2015.

Thorn, Betsy, et al. WIC Participant and Program Characteristics Final Report. 2015, United States Department of Agriculture. Retrieved from https://fns-prod.azureedge.net/sites/default/files/ops/WICPC2014.pdf.

World Health Organization Europe. (2003). The Solid Facts: Second Edition (R. Wilkinson & M. Marmot, Eds.). Social Determinants of Health. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf

Contact Information

Brooke Mehner, MPHPRAMS Data AnalystBureau of Family HealthIowa Department of Public HealthP: (515) 601-5329 | F: (515) 242-6384

brooke.mehner@idph.iowa.gov

Jennifer Pham, MPHPRAMS Project DirectorBureau of Family HealthIowa Department of Public HealthP: (515) 725-2833 | F: (515) 725-1760jennifer.pham@idph.iowa.gov